Sex after menopause

For most postmenopausal women, hormone-related changes are the primary factors that interfere with sexual satisfaction

Concern about the safety of hormone replacement has all but obscured one of the most pressing concerns for women of a certain age: the effects of menopause on their sex lives. Many are reluctant to ask their doctors a question uppermost in their minds: “What has happened to my desire for sex and my ability to enjoy it?”

With fully a third of their lives ahead of them, but with little or none of the hormones that fostered what may have been a robust sex life, many postmenopausal women experience diminished or absent sexual desire, difficulty becoming aroused or achieving orgasm, or pain during intercourse caused by menopause-related vaginal changes.

Sometimes the reasons for these problems go beyond hormones. Some women may consider themselves less sexually attractive as their bodies change with age, or they have partners who have lost interest in sex or the ability to perform reliably.

But for most postmenopausal women, hormone-related changes are the primary factors that interfere with sexual satisfaction. My friend Linda, for example, who lives in Pittsburgh, was 52 years old and recently married when her vibrant interest in sex suddenly plummeted, leading to a search for a way to restore it.

A more common situation is described by Pat Wingart and Barbara Kantrowitz in their informative book, Is It Hot in Here or Is It Me? (Workman, 2006): “You’re not in the mood a lot of the time. Most nights, you just wish your partner would roll over and go to sleep. When you do feel like a little action, it takes forever to get warmed up. Sometimes sex is more painful than pleasurable.”

COMMON CHANGES

Unlike Linda, who had an abrupt change in desire, many women report a gradual decline in sexual desire as they age. In a survey of 580 menopausal women conducted by SIECUS, the Sexuality Information and Education Council of the United States, 45 percent reported a decrease in sexual desire after menopause, 37 percent reported no change and 10 percent reported an increase.

A LIBIDO DRUG FOR WOMEN?

Since testosterone is the “libido hormone” for both men and women, therapists have long pondered the effectiveness and safety of providing testosterone treatments for postmenopausal women who have lost interest in sex.

Only one product, Estratest, is commercially marketed now, though it is not approved for treating low libido. And it contains estrogens, which may be unsafe for some women. The US Food and Drug Administration has thus far declined to approve a testosterone patch, though compounding pharmacies can prepare testosterone creams for individual customers.

A one-year placebo-controlled study published in November in the New England Journal of Medicine, involving 814 middle-age women with low libido,found that those treated with a patch providing 300 micrograms of testosterone a day experienced one additional satisfying sexual episode a month. But a patch at half the dosage provided no benefit. Side effects of the treatment were considered mild; they included increased hair growth and acne.

—JANE E. BRODY

Although individual experiences certainly vary, “Changes in arousal clearly are associated with menopause,” according to a 2007 article in the Journal of the American Medical Association. The author, Jennifer E. Potter of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, said physical factors include less blood flow to genital organs, a decrease in vaginal lubrication and a decreased response to touch.

Women can achieve orgasm throughout their lives, but they typically need more direct, more intense and longer stimulation of the clitoris to reach a climax, Potter noted.

Another common experience is a diminished intensity of orgasm and painful uterine contractions after orgasm, although the women surveyed by SIECUS said overall that they remained satisfied with sex.

Yet as Potter put it, “What might be a satisfying sexual life for one woman may seem woefully inadequate to another,” adding that what a woman expects from her sex life can make a difference. She cited the findings of various large surveys: “Only one-third to one-half of women who report decreased desire or response believe they have a problem or feel distress for which they would like help.”

So what happens to a woman’s body when levels of sex hormones fall?

Although estrogen is a woman’s predominant hormone before menopause, testosterone, produced in women primarily by the ovaries and adrenal glands, is considered the libido hormone for both men and women.